Professional Documents
Culture Documents
117
April 2010
Well conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias
1-
Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the
relationship is causal
2-
Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal
Expert opinion
GRADES OF RECOMMENDATION
Note: The grade of recommendation relates to the strength of the evidence on which the recommendation is based. It does not
reflect the clinical importance of the recommendation.
Evidence level 3 or 4; or
Extrapolated evidence from studies rated as 2+
Recommended best practice based on the clinical experience of the guideline development group
NHS Quality Improvement Scotland (NHS QIS) is committed to equality and diversity and assesses all its publications for likely
impact on the six equality groups defined by age, disability, gender, race, religion/belief and sexual orientation.
SIGN guidelines are produced using a standard methodology that has been equality impact assessed to ensure that these equality
aims are addressed in every guideline. This methodology is set out in the current version of SIGN 50, our guideline manual, which
can be found at www.sign.ac.uk/guidelines/fulltext/50/index.html. The EQIA assessment of the manual can be seen at www.sign.
ac.uk/pdf/sign50eqia.pdf. The full report in paper form and/or alternative format is available on request from the NHS QIS Equality
and Diversity Officer.
Every care is taken to ensure that this publication is correct in every detail at the time of publication. However, in the event of
errors or omissions corrections will be published in the web version of this document, which is the definitive version at all times.
This version can be found on our web site www.sign.ac.uk.
This document is produced from elemental chlorine-free material and is sourced from sustainable forests.
April 2010
CONTENTS
Contents
1 Introduction................................................................................................................. 1
1.1
1.2
1.3
Definitions.................................................................................................................... 1
1.4
Statement of intent........................................................................................................ 2
Key recommendations.................................................................................................. 3
2.1
2.2
General management.................................................................................................... 3
2.3
Surgical management.................................................................................................... 3
2.4
Postoperative care......................................................................................................... 3
Presentation................................................................................................................. 5
3.1
3.2
3.3
Clinical diagnosis.......................................................................................................... 6
4.2
Throat culture............................................................................................................... 7
4.3
5.2
5.3
6 Antibiotics ................................................................................................................... 10
6.1
6.2
6.3
6.4
6.5
7.2
7.3
7.4
Otolaryngological assessment....................................................................................... 15
7.5
Postoperative care......................................................................................................... 16
Management
of sore
throat
andcancer
indications for tonsillectomy
Control
of pain
in adults
with
Provision of information............................................................................................... 19
8.1
8.2
10.2
10.3
Introduction.................................................................................................................. 23
11.2
11.3
Acknowledgements....................................................................................................... 24
11.4
Abbreviations............................................................................................................................... 27
Annexes ..................................................................................................................................... 28
References................................................................................................................................... 35
1 INTRODUCTION
1 Introduction
1.1
1.3
definitions
Acute pharyngitis, tonsillitis, or acute exudative tonsillitis may all cause sore throat. For the
purpose of non-surgical management, these are considered together under the term sore
throat.
No accepted definition of childhood exists in Scots law or NHSScotland. Upper cut-off ages
used in studies of children included in this guideline vary from 12 to 16. For the purposes of
this guideline, recommendations concerning tonsillectomy in childhood apply to ages 4-16.
For prescribing in children, advice in the BNF for Children should be followed.2
2 KEY RECOMMENDATIONS
Key recommendations
The following recommendations were highlighted by the guideline development group as
the key clinical recommendations that should be prioritised for implementation. The grade of
recommendation relates to the strength of the supporting evidence on which the recommendation
is based. It does not reflect the clinical importance of the recommendation.
2.1
2.2
general management
A Ibuprofen 400 mg three times daily is recommended for relief of fever, headache and
throat pain in adults with sore throat.
A In adults with sore throat who are intolerant to ibuprofen, paracetamol 1 g four times
daily when required is recommended for symptom relief.
A
2.3
surgical management
A Watchful waiting is more appropriate than tonsillectomy for children with mild sore
throats.
A
A Routine use of anti-emetic drugs to prevent postoperative nausea and vomiting (PONV)
in tonsillectomy is recommended.
A A single intraoperative dose of dexamethasone (dose range 0.15 to 1.0 mg/kg; maximum
dose range 8 to 25 mg) is recommended to prevent postoperative vomiting in children
undergoing tonsillectomy or adenotonsillectomy.
B A single dose of 10 mg dexamethasone at induction of anaesthesia may be considered
to prevent PONV in adults undergoing tonsillectomy or adenotonsillectomy.
3 PRESENTATION
Presentation
3.1
3.2
2+
3.3
S ore throat associated with stridor or respiratory difficulty is an absolute indication for
admission to hospital.
4.1
clinical diagnosis
Precise clinical diagnosis is difficult in practice. Distinguishing between a viral and bacterial
aetiology is one of the main considerations. The most common bacterial pathogen is GABHS,
for which antibiotic treatment may be considered. Several studies have attempted to differentiate
between GABHS and viral causes on the basis of symptoms and clinical signs. No single
symptom or sign is useful when used alone, but combinations of factors have been used in
several clinical prediction rules. A systematic review of these studies has shown that the Centor
scoring system may help categorise the individual patients risk level for GABHS infection.13
The Centor score gives one point each for:
tonsillar exudate
tender anterior cervical lymph nodes
history of fever
absence of cough.
The likelihood of GABHS infection increases with increasing score, and is between 25-86%
with a score of 4 and 2-23% with a score of 1, depending upon age, local prevalence and
seasonal variation. Streptococcal infection is most likely in the 515 year old age group and
gets progressively less likely in younger or older patients.13 The score is not validated for use
in children under three years.
The use of a clinical prediction rule such as the Centor score gives a clinician a rational basis
on which to estimate the probability that a sore throat is due to GABHS, but cannot be relied
upon for a precise diagnosis. It may assist the decision on whether to prescribe an antibiotic.
C The Centor clinical prediction score should be used to assist the decision on whether
to prescribe an antibiotic, but cannot be relied upon for a precise diagnosis.
In addition to clinical examination, assessment of a patient with sore throat should take account
of other medical conditions and medication which may suggest an increased susceptibility to
infection and lower the threshold for treatment.
Occasionally, sore throat may be a presenting symptom of acute epiglottitis or other serious
upper airway disease.
;;
If breathing difficulty is present, urgent referral to hospital is mandatory and attempts to
examine the throat should be avoided.
2+
4.2
throat culture
A positive throat culture for GABHS makes the diagnosis of streptococcal sore throat likely
but a negative culture does not rule out the diagnosis. There are cases where streptococcus is
isolated from sore throats but there is no serological evidence of infection.14 The asymptomatic
carrier rate for GABHS is up to 40%.14,15 The flora of bacteria recovered from the surface of
the tonsil correlates poorly with that of those deep in the tonsillar crypts which are most likely
to be causing the infection.16,17 Symptoms also correlate poorly with results of throat swab
culture.18
Throat swabs are neither sensitive nor specific for serologically confirmed infection, considerably
increase costs, may medicalise illness, and alter few management decisions.19
D Throat swabs should not be carried out routinely in primary care management of sore
throat.
;;
Throat swabs may be used to establish aetiology of recurrent severe episodes in adults
when considering referral for tonsillectomy (see section 7.2.2).
4.3
A study in Canada showed that RAT use reduced antibiotic prescribing. The rate of antibiotic
prescribing for sore throat in the control group was 58.2%. A Swiss study showed lower antibiotic
use after RAT when compared to giving antibiotics for all patients with Centor score 3 or 4. The
findings cannot be generalised to Scotland because the rate of antibiotic prescribing for sore
throat in Scotland is unknown.22, 23 Further studies are required to evaluate the cost effectiveness
and clinical benefit of RAT in Scotland.
Insufficient evidence was identified to support a recommendation.
1++
Ibuprofen is available over the counter and is only slightly more expensive than paracetamol.
A large blinded randomised controlled trial (RCT) involving 8,633 European adults showed
that ibuprofen is as well tolerated as paracetamol and produces fewer serious gastrointestinal
adverse effects, irrespective of patient age, in short courses for acute pain.27
1++
Ibuprofen should not be routinely given to adults with or at risk of dehydration due to concerns
regarding renal toxicity although this serious adverse effect is rare.
No head to head trials that compared ibuprofen and diclofenac were identified.
A Ibuprofen 400 mg three times daily is recommended for relief of fever, headache and
throat pain in adults with sore throat.
A systematic review has shown that ibuprofen does not exacerbate asthma morbidity in a
paediatric population.28 Caution is advised using ibuprofen in adults with asthma as similar
evidence in adults could not be found.
1+
One RCT showed that aspirin and paracetamol are both equally effective, and superior to
placebo, at reducing fever, headache, achiness and throat pain for up to six hours.29 The
recognised complications of aspirin therapy make this agent less suitable for general use.
1++
A In adults with sore throat who are intolerant to ibuprofen, paracetamol 1 g four times
daily when required is recommended for symptom relief.
Ibuprofen and paracetamol are often used together. Evidence concerning the safety and efficacy
of this combination in adults is lacking, but is available in children (see section 5.2).
In children with sore throat, an adequate dose of paracetamol should be used as first
line treatment for pain relief.
A systematic review and meta-analysis of ibuprofen and paracetamol use in febrile children
and occurrence of asthma-related symptoms showed that there is a low risk of asthma-related
morbidity associated with ibuprofen use in children.28
A
Recent case reports have highlighted concern about renal toxicity in dehydrated children given
ibuprofen.30, 31
D
1+
5.3
adjunctive therapy
No good quality evidence on the effectiveness of non-prescription throat sprays, lozenges and
gargles was identified. No studies provided evidence of lasting benefit. No trials compared
these products with conventional analgesics. There is insufficient evidence to support a
recommendation.
5.3.1 corticosteroids
Three trials of varying quality on the effectiveness of a single dose of oral dexamethasone for
pharyngitis in children produced conflicting results.34-36 Larger, well designed trials are required.
The evidence is insufficient to support a recommendation.
1++
1+
1-
One RCT looking at effectiveness of prednisone in pharyngitis was carried out on a relatively
small number of patients (n=79) and the follow up was short.37
1+
1+
6 Antibiotics
6.1
1+
Even if the sore throat persists, a throat swab to identify GABHS may not be helpful, as the poor
specificity and sensitivity of throat swabs limit their usefulness (see section 4.2). Nevertheless,
randomised controlled trials of antibiotic therapy in patients with acute sore throat in whom
GABHS has or has not been isolated (whether or not causative) have been reported. There is
no evidence of clear clinical benefit from the use of any particular antibiotic.
6.1.1
6.1.2
;;
In view of increases in healthcare-acquired infections and antibiotic resistance in the
community, unnecessary prescribing of antibiotics for minor self limiting illness should
be avoided.
;;
In severe cases, where the practitioner is concerned about the clinical condition of the
patient, antibiotics should not be withheld. (Penicillin V 500 mg four times daily for 10
days is the dosage used in the majority of studies. A macrolide can be considered as an
alternative first line treatment, in line with local guidance.)
10
1+
6 ANTIBIOTICS
6.2
;;
;;
mpicillin-based antibiotics, including co-amoxiclav, should not be used for sore throat
A
because these antibiotics may cause a rash when used in the presence of glandular
fever.
1+
1-
1-
The general use of antibiotics involves the risk of the development of resistant bacteria, the risk
of adverse effects including allergic reactions, promotion of Candida infections, and increased
prescribing costs.
;;
6.3
2+
C Sore throat should not be treated with antibiotics specifically to prevent the development
of rheumatic fever and acute glomerulonephritis.
11
6.4
6.5
12
2+
7.2
7.2.1 children
No study demonstrated clear clinical benefit of tonsillectomy in children. A Cochrane review
showed modest benefit of tonsillectomy or adenotonsillectomy in the treatment of recurrent
acute tonsillitis.75 In this review, in those children with severe recurring tonsillitis the benefit was
a reduction in the number of sore throats by three episodes in the first postoperative year, one
of those episodes being moderate to severe. The reduction in sore throats in the severe group
is accompanied by one episode of sore throat as a direct consequence of the surgery itself. In
the case of less severely affected children, the benefit of tonsillectomy or adenotonsillectomy
is more modest, with a reduction by one episode of sore throat in the first postoperative year,
reducing the number of sore throat days from 22 to 17 on average.
1++
No recent studies evaluated tonsillectomy in children with severe sore throats, the group that
is assumed to be the most likely to benefit from surgical intervention.
An RCT conducted in the Netherlands of 300 children aged 2 to 8 years with mild to moderate
sore throat found that adenotonsillectomy was not cost effective in mild to moderate sore throat
and did not result in significant clinical benefit.76
1+
1++
1+
13
1+
1-
Although rare complications have been reported, the risk of these occurring should not be a
barrier to decision making in the group for whom tonsillectomy is felt to be beneficial.85
A Watchful waiting is more appropriate than tonsillectomy for children with mild sore
throats.
Adenotonsillectomy in children with obstructive sleep apnoea and in patients with rare
conditions such as periodic fever is outwith the scope of this guideline.
7.2.2 adults
A Cochrane review found limited evidence of benefit of tonsillectomy in adults.75
1++
In adults with proven recurrent group A streptococcal pharyngitis (GAHSP), a small well
conducted RCT demonstrated benefit for tonsillectomy in adults. Tonsillectomy reduced the
incidence of GAHSP in the 90-day postoperative period with a number needed to treat (NNT)
of 5.86
1++
7.3
14
7.4
otolaryngological assessment
Patients referred will rarely be seen by a specialist during an acute episode of sore throat, so the
diagnosis of recurrent acute tonsillitis rests with the referring doctor. Questioning the patient
about the appearance of the throat, the degree of systemic upset, and the presence of tender
neck lymph nodes can help confirm the diagnosis.
The specialist should also confirm the frequency of occurrence of the episodes and assess the
associated disability. If the criteria set out above are confirmed, the management options should
be discussed and the benefits of tonsillectomy weighed against the natural history of resolution
and the temporary incapacity associated with tonsillectomy. This information may be reinforced
by means of an appropriately designed patient information leaflet (see Annexes 2 and 3). The
rate of readmission for bleeding should also be stated as part of informed consent.
In some cases this will be the first discussion the patient or parents have had which takes into
account all factors for and against surgery. In addition the frequency of episodes is often an
impression rather than fully documented. Under these circumstances a period of watchful
waiting of at least six months, during which the patient or parent can more objectively record
the number, duration and severity of the episodes, may be suggested. This would allow a more
balanced judgement to be made as to the likely benefit or otherwise of tonsillectomy. This
could either be reported to the GP after six months, who would then refer again if appropriate,
or be reported by the patient at a pre-arranged review hospital appointment.
;;
15
7.5
Postoperative care
Patients frequently experience significant postoperative morbidity following a tonsillectomy.
This can include throat and ear pain, fever, poor oral intake, halitosis, and decreased activity
levels. Pain is associated with a delay in return to normal activity and diet for patients. This
problem can have an impact on the recovery of tonsil beds and lead to a secondary bleed.
;;
1+
3
The single cohort study showed that a subgroup of patients post-tonsillectomy who had an
unscheduled medical consultation had significantly more pain (and took significantly more
analgesic) on days 5-7.92
D Patients should be made aware of the potential for pain to increase for up to 6 days
following tonsillectomy.
;;
7.5.2
atients/carers should be given written and oral instruction prior to discharge from
P
hospital on the expected pain profile and the safety profile of the analgesic(s) issued with
particular reference to appropriate dose and duration of use. They should be issued with
enough analgesic to last for a week.
local anaesthesia
It is not routine clinical practice in Scotland to administer local anaesthesia (LA) for tonsillectomy.
Over the last decade, the routine use of perioperative LA infiltration has declined in Scotland,
as improved alternative analgesia and anti-emetic regimens have been developed.
A Cochrane review found no evidence to support the use of either local anaesthetic infiltration
or topical application.93 Five good quality RCTs have found no benefit.94-98
There is some evidence to support analgesia benefit in the first few hours postoperatively but
this evidence is arguably obsolete in the context of current practice.99-105
Four studies describe some prolonged benefit beyond 24 hours but include additional injectate
(fentanyl and clonidine) or small numbers.106, 107 One well conducted RCT in children and adults
showed benefit for several days with a slow release topical method.108 Improved analgesia
beyond that provided with paracetamol/NSAID/opiate/anti-emetic remains unproven.
As there is conflicting evidence from well conducted trials, no recommendation on use of LA
can be made.
16
1++
1++
1++
A Cochrane review concluded that a single intraoperative dose of dexamethasone (dose range
0.15 to 1.0 mg/kg; maximum dose range 8 to 25 mg) is effective, relatively safe and inexpensive
for reduction of paediatric emesis after tonsillectomy and adenotonsillectomy. Treating four
children will prevent one episode of emesis (NNT=4). No complications were found as a result
of dexamethasone administration.112
1++
A A single intraoperative dose of dexamethasone (dose range 0.15 to 1.0 mg/kg; maximum
dose range 8 to 25 mg) is recommended to prevent postoperative vomiting in children
undergoing tonsillectomy or adenotonsillectomy.
One RCT (n=215) of dexamethasone published after the Cochrane review showed a dose
dependent reduction in PONV in children undergoing tonsillectomy. The study reported
an increase in postoperative bleeding, which has not been seen in other studies. Three
different methods of tonsillectomy were used, which adds to the uncertainty regarding the
conclusion.113
1+
One well conducted double blind RCT on the effectiveness of dexamethasone for preventing
PONV in adults was identified. The study involved 72 patients (80% female) aged 16 to 42 with
a completion rate of 64%. Those treated with dexamethasone 10 mg intravenously at induction
of anaesthesia had significantly less PONV on the day of operation (p=0.001), although on
subsequent days there was no significant difference between the groups.88
1+
1++
17
No studies on the effectiveness of fasting for prevention of PONV in adults were identified. A
Cochrane review on preoperative fasting in children included a wide variety of operations and
it is not clear how many studies included tonsillectomies.117 Of the 23 RCTs included, only one
reported on postoperative vomiting and none reported on nausea. The fasting regimens favoured
in the Cochrane review are already adopted in many paediatric centres for all operations.
There is insufficient evidence to make a recommendation on fasting prior to tonsillectomy for
the prevention of PONV.
18
8 PROVISION OF INFORMATION
Provision of information
This section reflects the issues likely to be of most concern to patients and their carers. These
points are provided for use by health professionals when discussing recurrent sore throat and
tonsillectomy with patients and carers and in guiding the local production of information
materials.
8.1
19
-----
Treatment
Advise patients/carers how to relieve symptoms and manage pain
Inform patients that if antibiotics are prescribed the course should be completed
Inform patients that most sore throats can be self-managed and that persistent sore
throats can be managed in primary care. Inform patients of referral criteria for
tonsillectomy
Inform patients that there is no guarantee that tonsillectomy will prevent ALL sore
throats in the future; inform patients of the difference between bacterial and viral sore
throat
Advise patients of length of stay, the need for general anaesthetic and potential
complications, ie bleeding.
Post-surgery
Advise on recovery time and expected loss of time from education/work
Inform patients of foods that may cause discomfort and the importance of adequate
fluid intake.
Discharge
E nsure patients are aware that pain may increase for up to 6 days following
tonsillectomy and that they should continue to take adequate analgesia
Provide written information advising whom to contact and at what hospital unit or
department to present if they have postoperative problems or complications.
20
21
10.1.1
10.2
10.3
22
introduction
SIGN is a collaborative network of clinicians, other healthcare professionals and patient
organisations and is part of NHS Quality Improvement Scotland. SIGN guidelines are developed
by multidisciplinary groups of practising clinicians using a standard methodology based on a
systematic review of the evidence. The views and interests of NHS Quality Improvement Scotland
as the funding body have not influenced any aspect of guideline development, including the final
recommendations. Further details about SIGN and the guideline development methodology are
contained in SIGN 50: A Guideline Developers Handbook, available at www.sign.ac.uk.
11.2
The membership of the guideline development group was confirmed following consultation
with the member organisations of SIGN. All members of the guideline development group
made declarations of interest and further details of these are available on request from the SIGN
Executive. Guideline development and literature review expertise, support and facilitation were
provided by the SIGN Executive.
Mary Deas
Lesley Forsyth
Karen Graham
Stuart Neville
Gaynor Rattray
23
11.3
acknowledgements
SIGN is grateful to the following former member of the guideline development group who
contributed to the development of this guideline.
Dr Fiona Bisset
Consultant in Public Health Medicine, Directorate of Health
and Wellbeing, Scottish Government
SIGN would like to acknowledge the guideline development group responsible for SIGN 34:
Management of Sore Throat and Indications for Tonsillectomy, on which this guideline is
based.
Mr William McKerrow
(Chair)
Dr Ann Bisset
Mr Robin Blair
Professor George Browning
Mr John Dempster
Dr Jill Morrison
Dr Barney Reilly
Ms Susan Renton
Dr George Russell
Mr David Sim
11.4
24
25
26
ABBREVIATIONS
Abbreviations
A&E
BNF
CI
confidence interval
ENT
GABHS
GAHSP
GP
general practitioner
LA
local anaesthesia
MTA
NHS QIS
NICE
NNT
NSAID
OR
odds ratio
PCR
PONV
RAT
RCT
SIGN
SMC
27
Annex 1
Key questions used to develop the guideline
The following questions were used to inform the process of identifying, sifting, and including or
excluding evidence for use in the guideline development process. Key questions are structured
(where appropriate) according to the PICO format, specifying patient group or population,
intervention, comparison, and outcome.
THE KEY QUESTIONS USED TO update SIGN 34
DIAGNOSIS
Key question
Inclusion/exclusion criteria
Consider gastro-oesophageal
reflux and H. pylori
4.3
MANAGEMENT
Inclusion/ exclusion criteria
4. A. Which analgesic
(or combination of
analgesics) is most
effective in adults with
sore throat in terms of
speed and duration of
pain relief?
5. Which adjunctive
Benzydamine (topical agents),
therapies are useful in sore sprays, lozenges (eg Fishermans
throat in terms of pain
Friends), gargles, steroids
relief and dysphagia?
(consider harms and adverse
effects from long term use)
28
Key question
5.3
ANNEXES
6. D
oes the use of the
following antibiotics in
acute sore throat (a) relieve
symptoms (b) prevent
sequelae (c) prevent
complications (eg abscess
formation, breathing
problems, quinsy/
peritonsillar abscess)?
6.1
6.2
6.2
Inclusion/exclusion criteria
7.2
7.2
7.3
7.5.2
7.5.1
29
30
Consider intraoperative
corticosteroids, anti-emetic
injections, acupuncture/
acupressure, intravenous fluids,
preoperative fasting regimens,
premedication
7.5.3
This is normal while the throat heals. You may also see
small threads in your childs throat - sometimes these are
used to help stop the bleeding during the operation, and
they will fall out by themselves.
Disclaimer
This publication is designed for the information of patients. Whilst every effort has been
made to ensure accuracy, the information given may not be comprehensive and patients
should not act upon it without seeking professional advice.
ENT.UK
The Royal College of Surgeons of England
ABOUT
CHILDRENS
TONSIL SURGERY
ANNEXES
Annex 2
Reproduced with permission from ENT-UK (British Association of Otorhinolaryngology Head and Neck Surgery)
31
32
The removal of
enlarged tonsils
like this can
relieve the airway.
Your child will not always need to have his or her tonsils
out. You may want to just wait and see if the tonsil problem
gets better by itself. Children often grow out of the
problem over a year or so. The doctor should explain to
you why he or she feels that surgery is the best treatment.
We only take tonsils out if they are doing more harm than
good. We will only take your childs tonsils out if he or she
is getting lots of sore throats, which are making him or her
lose time from school. Sometimes small children have
tonsils so big that they block their breathing at night.
Your child will be asleep. We will take his or her tonsils out
through the mouth, and then stop the bleeding. This takes
about 20 minutes. Your child will then go to a recovery
area to be watched carefully as he or she wakes up from
the anaesthetic. He or she will be away from the ward for
about an hour in total.
Possible complications
If you notice any bleeding from your throat, you must see
a doctor. Call your GP, call the ward, or go to your nearest
hospital casualty department.
Make sure you rest at home away from crowds and smoky
places. Keep away from people with coughs and colds.
Your may feel tired for the first few days.
Disclaimer
This publication is designed for the information of patients. Whilst every effort has been
made to ensure accuracy, the information given may not be comprehensive and patients
should not act upon it without seeking professional advice.
ENT.UK
The Royal College of Surgeons of England
ABOUT
ADULT TONSIL
SURGERY
ANNEXES
Annex 3
Reproduced with permission from ENT-UK (British Association of Otorhinolaryngology Head and Neck Surgery)
33
34
You will not always need to have your tonsils out. You
may want to just wait and see if the tonsil problem gets
The removal of
enlarged tonsils like
this can relieve
airway obstruction.
We only take them out if they are doing more harm than
good. We take tonsils out if they cause recurrent sore
throats despite treatment with antibiotics. The other main
reason for removing tonsils is if they are large and block
the airway. A quinsy is an abscess that develops alongside
the tonsil, as a result of tonsil infection, and is most
unpleasant. People who have had a quinsy therefore often
choose to have a tonsillectomy to prevent having another.
Tonsils are also removed if we suspect there is a tumour in
the tonsil. A rapid increase in the size of a tonsil or
ulceration or bleeding occurs if a tumour of the tonsil
develops. Tumours of the tonsil are rare.
Arrange for two weeks off work. Let us know if you have
a chest infection or tonsillitis before your admission date
because it may be better to postpone the operation. It is
very important to tell us if you have any unusual bleeding
or bruising problems, or if this type of problem might run
in your family.
This is normal while your throat heals. You may also see
small threads in your throat - they are used to help stop the
bleeding during the operation, and they will fall out by
themselves.
Eating food will help your throat to heal. It will help the
pain too. Drink plenty of water and stick to bland non
spicy food. Chewing gum may also help the pain.
Possible complications
REFERENCES
References
1.
35
36
REFERENCES
37